Mitford Hospital Research Articles

Negative Pressure Wound Therapy in the Management of Postoperative Abdominal Wound Dehiscence

Background: Abdominal wound dehiscence(AWD) is one of the dreadful complications of abdominal surgery. Conventionally it is treated with regular dressing. Negative pressure wound therapy (NPWT) is newest concept for management of AWD. Objective: To find out the effectiveness of NPWT in management of AWD. Material & methods: This prospective study was conducted in the Department of Plastic and Reconstructive Surgery, Sir Salimullah Medical College (SSMC) and Mitford Hospital, Dhaka, Bangladesh from July2018 to June2020. Total 30 patients were fulfilled the enrollment criteria. Result: Age range of our patient was 15-60 and mean (SD) was 36.5 (± 12.204) years. Male to female ratio was 1.5:1. AWD commonly (60.66%) occurred after emergency procedure. The mean (SD) wound size waschanged from 60.21(±31.418) cm3 to 12.19(±7.453) cm3 at the end of treatment that was statistically significant. The average duration of NPWT was 8.26 days. Conclusion: The wound healing process is aided by NPWT, which makes the wound bed more favorable to early covering and reduces the mental stress and financial burden of the patient.

Frequency of Stress Hyperglycemia in Acute Ischemic Stroke with Immediate Mortality

Introduction: Stroke is a leading cause of morbidity, death, and a significant socioeconomic burden. This is especially true in poor nations like Bangladesh, where the health-care system, including rehabilitation, is out of reach for the average citizen. This life-threatening ailment impacts not only the patients but also their families. The goal of this hospital-based study was to determine stroke-related in-hospital mortality. For various reasons, the findings of our study are important to stroke care in our setting. Attention to modifiable variables that have a negative influence on stroke outcome (e.g. hyperglycemia and comorbidities) may help to reduce stroke mortality, which is particularly high in poor countries. The aim of the study was to evaluate the frequency of stress hyperglycemia in acute ischemic stroke cases, and observe the difference in mortality and morbidity among patients with hyperglycemia and normoglycemia. Methods: This observational cross-sectional study was conducted at the Department of Medicine, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. The study duration was 6 months, from April 2017 to October 2017. The purposive sampling technique was used to select a total of 100 consecutively attending first-ever acute ischemic stroke patients attending the study hospital within 72 hours of stroke onset. Result: Among the participants, the majority (54%) were between the age range of 41-55 years, with a mean age of 58.37 (±6.23) years. The male: female ratio was 1.7:1. Over half the participants were from urban areas, and 29% were housewives while 25% were businessmen. Unilateral weakness, speech disturbance, and headache were the most common clinical presentations. During admission, the majority were conscious, while 7% were unconscious. Stress hyperglycemia was observed in 29% of the cases. Recovery rates were higher among normoglycemic patients. Conclusion: Present study showed that stress hyperglycemia is .............

Comparison of Clinical Presentation and Per-operative Findings of Laparoscopic Assisted Vaginal Hysterectomy

Background: Laparoscopically assisted vaginal hysterectomy can be very useful surgery.
 Objective: The purpose of the present study was to evaluate the clinical diagnoses and preoperative findings with their histopathological results due to hysterectomy.
 Methodology: This was a retrospective Observational study carried out Department of Obstetrics and Gynaecology at Sir Salimullah Medical College & Mitford Hospital (SSMC & MH), Dhaka, Bangladesh. Patients requiring of laparoscopic assisted vaginal hysterectomy, admitted in the Department of Obstetrics and Gynaecology, SSMC & MH, Dhaka. The patients having of laparoscopic assisted vaginal hysterectomy were interviewed, clinical examination was done and per operative findings and histopathological reports were recorded accordingly.
 Results: The commonest indication for laparoscopic assisted vaginal hysterectomy in the series is leiomyoma uterus (26%) and dysfunctional uterine bleeding is the second most common (24.0%) indication. Commonest complaint of the patients suffering from dysfunctional uterine bleeding (DUB) was irregular bleeding. Among the 12 cases of clinically diagnosed DUB. About 11 cases had no apparent organic lesion and 10 cases were confirmed by histopathological examination to have no organic lesion. Peroperative findings were similar to clinical diagnosis in 88.0% cases and histopathological findings were similar to clinical diagnosis in 82.0% cases.
 Conclusion: Clinical diagnoses in hysterectomy patients are mostly consisted with the per-operative findings and also with the histopathological findings.
 Journal of Current and Advance Medical Research, January 2022;9(1):26-31

A Retrospective Observational Study Of Eeg Findings in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Electroencephalography (EEG) is an electrophysiological observing strategy to record the electrical activity of the brain which is used in a seizure disorder, organicity, and psychiatric conditions. In spite of the overwhelming burden of epilepsy in Bangladesh, there remains a relative scarcity of neurophysiology services and restricted distributed information on electroencephalography (EEG) highlights among the population. The aims of the study to explore the EEG findings of distinctive cases and their associations in various clinical scenarios. Methods: This study was a hospital-based retrospective study on the patients who underwent EEG in the EEG room in the department of Neurology & Medicine in Sir Salimullah Medical College & Mitford Hospital, Dhaka during January 2018 to December 2018. Data were recorded from EEG registers and reports. Data were analyzed utilizing SPSS version 25. Frequency distribution was studied and the Chi-Square test and Logistic Regression were applied for categorical variables. Results: Of the total 245 patients studied, he median age was 10.90 +/- 22.1 years and 53.9% were male. The patient attended for performing EEG the initial clinical diagnosis is not mentioned (64.5%). The commonest reason for EEG referral was to rule out seizure disorder (78.0%), requested mostly from the outpatient department (OPD). EEG abnormality was seen in 35.9% of patients and the site of EEG abnormality in the brain was hemispheric epilepsy (19.2%). The most common type of EEG abnormalities was slow-wave (9.8%). EEG diagnosis was normal (64.5%) most of the patients, whereas the rest of them (35.5%) diagnosed as epilepsy. The EEG abnormality detection rate was significant in those referred from the Department of the out-patient department (OPD) and Neurology. Conclusion: Epilepsy is more common in younger male and the most of the EEG were normal. The commonest type of abnormalities in EEG pattern was slow wave which was hemispheric. Bangladesh J Medicine 2022; 33: 138-144

Comparison of Efficacy and Tolerability of Ferrous Sulfate and Carbonyl Iron in Iron Deficiency Anemia in Pregnant Woman

Introduction: Iron deficiency anemia in pregnancy is common and causes a huge burden globally. Bangladesh is known to have a high prevalence of iron deficiency anemia in pregnant women. Hence, it is important to evaluate the efficacy and tolerability of drugs in treatment of iron deficiency anemia in pregnancy.
 Objective: The purpose of present study was to compare the efficacy and tolerability of Ferrous Sulfate and Carbonyl Iron in Iron Deficiency Anemia in pregnant women.
 Methodology: An observational prospective study was conducted in obstetric and gynae out – patient department of Sir Salimullah Medical College and Mitford Hospital. Woman between 16 – 28 weeks of pregnancy with haemoglobin level 7 – 10 g/dl with microcytic hypochromic blood film were included in this study. Pregnant women in 1st and 3rd trimester of pregnancy were excluded from the study. Among the study population one group was given Tablet Ferrous Sulfate and another group was given Capsule Carbonyl Iron.
 Results: There was significant and comparable rise in HB in 4th, 8th and 12th week in the two group. (p<0.001). Carbonyl iron showed significantly more rise in Hb as compared to Ferrous Sulfate. Adverse effects were seen more in number and intensity with Ferrous Sulfate. Individual efficacy of both compounds was good but Carbonyl Iron was better tolerated.
 Conclusion: Carbonyl Iron is more effective and tolerable than Ferrous Sulfate in treatment of iron deficiency anemia in pregnancy.
 Sir Salimullah Med Coll J 2022; 30: 83-88

Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

Background: Chronic kidney disease (CKD) is a global health problem associated with increased risks of morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until progressive damage occurs and produce multiple symptoms and signs. Progressive loss of kidney function in CKD leads to reduced production of 1-á-(OH) 2-D3 (1, 25-dihydroxyvitamin D; calcitriol) and abnormal mineral homeostasis. The aim of the study was planned to assess the mineral and bone disorder in CKD patients admitted in a tertiary care hospital. Methods: A Cross sectional observational study was performed at a tertiary care centre. 100 cases of diagnosed Chronic Kidney Disease patients in indoor of department of Nephrology and Medicine of Sir Salimullah Medical College Mitford hospital from March 2018 to August 2018 were included in this study. Results: Majority of the patients (60%) were of age between 46 and 65 years. 31% of the study population were older than 65 years. 72% of the study population were male and 28% were female. Diabetic nephropathy was the leading cause of CKD, affecting 36% of the study population. Hypertension was the likely cause in 26% of the subjects. Obstructive uropathy and chronic glomerulonephritis affected 7% and 5% of the subjects respectively. There was one (1%) patient with ADPKD, and in 25% of the cases no causative factor was identified. Most (40%) of the study subjects were in the stage 3 of CKD. 34% & 26% of the patients were in the stage 5 & 4 respectively. We did not find any patient with normal vitamin D level. 10% of the patients were in the insufficient range and 90% of the study subjects were deficient in vitamin D. Hyperparathyroidism was prevalent in 75% of the study subjects. 79% of the patients had elevated serum phosphate levels. Hypocalcemia was found in 49% of the patients. 33% of the patients had hyperkalemia during admission. Hyperphosphatasia was prevalent in 39% of the study subjects. However, bone fraction of the ALP was not tested. Among stages 3B, 4 and 5 CKD patients, there were 2% patients in each group that were insufficient in vitamin D. Majority (32% in stage 5, 24% each in stages 3B and 4) were deficient in vitamin D. Deficiency was also prevalent in earlier stages of CKD (10% patients in stage 3A). The difference was statistically significant, that is, the later the stage of CKD the greater the prevalence of vitamin D deficiency was. All the patients in stage 5 and 4 (34% and 26% respectively) had hyperparathyroidism. 0% and 15% of the patients in stages 3A and 3B respectively had hyperparathyroidism. The difference between groups was statistically significant. Serum calcium level correlated well with the stage of CKD. Most of the patients in stage 5 were hypocalcemic (32 among 34). Among the 39% of the total study population with hyperphosphatasia, 24%, 9% and 6% were in stages 5, 4 & 3B respectively. Which were statistically significant. 49% pf the patients had hyperparathyroidism with hypocalcemia, 26% of the patients had hyperparathyroidism and normal serum calcium levels. None of the patients had hypocalcemia and normal PTH level. Among the 90 patients with deficient vitamin D levels, 46 had hypocalcemia also. 70 patients with deficient vitamin D level also had high PTH level. The difference between groups which was statistically significant. Conclusion: MBD is a common complication in our CKD patients. Raised PTH, low 25(OH) D, and raised phosphorus levels were the most prevalent markers. Majority of our patients presented, or were referred late. Clinical features of MBD in CKD were poor guides to the presence of MBD in our pre-dialysis patients. Bangladesh J Medicine 2022; 33: 145-153

Pattern of Thyroid Swelling – A Histopathological Study

Background: This is a cross sectional study. The purpose of the study was to determine the histopathological pattern in Thyroid swellings. The study was done in the department of Otolaryngology and Head-Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka from December 2015 to December 2016. Fifty patients of Thyroid swelling were studied by detailed history, clinical examination, thyroid hormone assay, ultrasonography, Thyroid scan, FNAC and Histopathological examination.
 Results: In this study it was found that Goitre is predominant in female. Among the 50 cases nodular colloid goitre was found in 25 cases in FNAC suspicious cell for malignancy in 2 cases, follicular neoplasm in 11 cases & malignancy in 11 cases. Histopathology reports were obtained in all cases. Histopatholgical findings of the swelling shows that 42.0% of the swelling are Nodular colloidal goiter and 24.0% tumor are follicular adenoma and thyroiditis was found in 8 % cases. Among malignancy papillary carcinoma was in 20% cases while folicullar carcinoma and medullary carcinoma was 4% and 2% respectively. No case of anaplastic carcinoma and lymphoma was found. Proportion of papillary carcinoma was highest in the age group 30 years and below and proportion of follicular carcinoma was highest in age group above 50 years patients while nodular colloidal goiter was highest in age group 31 to 50 years patients.Thyroiditis was highest in the age group 31 to 50 year’s patients and follicular adenoma was highest in the age group above 50 years patients. Proportion of follicular carcinoma (25.0%) and medullary carcinoma (12.5%) was higher in male patients than female. On the other hand proportion of nodular colloidal goiter (40.5%), thyroiditis (9.5%), papillary carcinoma (21.4%) and follicular adenoma (26.2%) was higher in female patients than male.
 Conclusion: Clinical evaluation of goiter should be thorough, and use all means especially histopathologic study of the specimens to arrive at a definitive diagnosis as thyroid carcinoma is not uncommon.
 Sir Salimullah Med Coll J 2022; 30: 75-82

A Quasi Experiment on Outcome of Mirabegron and Solifenacin in the Treatment of Primary Over Active Bladder in A Tertiary Hospital in Dhaka, Bangladesh

Background: Overactive bladder (OAB) syndrome is a common symptom complex that affects millions of people worldwide, with an increasing prevalence with increased age in primary overactive bladder.
 Objective: The study was done to find out the efficacy and outcome of Mirabegron and solifenacin on primary overactive bladder.
 Methodology : This study was a quasi-experimental study conducted on 100 study population (Group A-50 Group B-50) in Urology Outpatient Department, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2017 to December 2018. Study population were total 100 men and women aged at least 18 & up to 60 years (Group A -50 and Group B-50) with persistent primary overactive bladder (OAB) symptoms for 3 months or more were enrolled in this study. Patients were eligible for the study who were able to give a written informed consent before starting the intervention & was also able to complete a voiding diary. Patients were recruited at the urology outpatient department, SSMCMH, Dhaka and were selected by the following inclusion and exclusion criteria. A data sheet was completed for each patient which included particulars of the patient, history, examination findings and baseline investigations. Half of the patients were enrolled in each group. Mirabegron group was experimental group and Solifenacin group was control group. Cases of Mirabegron group was given once daily dose of Mirabegron 25 mg and Solifenacin group was also given single dose of Solifenacin succinate 5 mg, at for 12 weeks.
 Result: The result of age distribution of the study patients belonged to age 31-40 years in group A (Mirabegron 25 mg) 21(42.0%) and 16(32.0%) in group B (Solifenacin 5 mg). The mean voided volume of each micturation at 12 week of treatment was more increased in group A (Mirabegron 25 mg) than group B (Solifenacin 5 mg). The mean change in micturition frequency per 24 hours, episodes of urgency per 24 hours, urge incontinence episodes per 24 hours and nocturia episodes per 24 hours were statistically significant (p<0.05) between group A (Mirabegron 25 mg) and group B (Solifenacin 5 mg).
 Conclusion The study shows that Mirabegron is more effective than Solifenacin in the treatment of primary over active bladder and can be used in without organic and pathological diseases of urinary bladder
 Sir Salimullah Med Coll J 2022; 30: 55-60

Pattern of ENT Emergencies in Tertiary Level Hospital

Background: Emergencies in ENT practice has a wide spectrum and management of each condition requires specialized skills. Crucial decisions are necessary to save patients life in hurried situations.
 Objectives: This study is carried out with an objective to find out pattern of ENT emergencies in tertiary level hospital.
 Methods: This is a cross sectional study was done in two major tertiary level hospitals (Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital) of Dhaka, Bangladesh. This study was conducted in a period of six months and took into account all inpatient and outpatient emergencies in this period. These included 496 patients either admitted as emergency or took emergency treatment without admission from department of ENT and Head-Neck surgery of two tertiary level hospitals.
 Results: 496 patients of between age ranges 2 months-80 years with a mean age 26.3 years were included. Male female ratio was 1.9:1.55.65% patients are from rural area. The total throat related cases were maximum (40.52%) in comparison to ear (32.26%) and nose (27.22%). Inflammatory condition in pharynx (46.27%) is the most common among throat related emergencies, followed by foreign body in throat (32.26%). Fish bone impaction is the most common (33.36%) emergencies among foreign body in throat. Foreign body in throat was mostly seen in 0 to 10 age group. Acute upper respiratory tract infection is the highest (27.96%) among the pharyngeal emergencies. Laryngeal emergencies with stridor were most common (47.62%) among laryngeal, tracheal and bronchial emergencies other than foreign body. Among the otological emergencies external ear emergencies other than foreign body (40%) was most common. Vegetables foreign body in the ear was most common (40%) among the foreign body in ear. Foreign body in ear mostly found in 0 to 10 age group. Traumatic injury to external ear is the most common (18.75%) among external ear emergencies other than foreign body. Among the sinonasal emergencies epistaxis was most common (39.26%). Most of the cases were managed surgically (71.97%) 87.5% cases were recovered from emergencies with overall mortality of (1.21%).
 Conclusion: Epistaxis emerged as the leading cause of ENT emergencies followed by foreign body in ENT region. Most of the ENT emergencies were managed surgically under local anaesthesia. So, presence of otolaryngological department in thana and district level hospital could avoid unnecessary referral.
 Sir Salimullah Med Coll J 2022; 30: 67-74

Transabdominal Ultrasonographic Evaluation of Enlarged Prostate with Histopathological Comparison

Introduction: The prostate is an accessory gland of the male reproductive system. It can be involved by a number of diseases ranging from inflammation to malignant diseases. Most common causes of prostatomegaly are benign prostatic hyperplasia, prostatitis, intraprostatic and periprostatic cyst, prostatic adenocarcinoma. Objectives: To evaluate the diagnostic usefulness of Transabdominal ultrasonography in enlarged prostate and compare the USG findings with the histopathological findings. Method: This cross sectional study was carried out in Radiology and Imaging Department of Sir Salimullah medical college and Mitford hospital, Dhaka, from January 2014 to December 2015 with clinically suspected enlarged prostate by department of Urology and referred to the Radiology and Imaging Department for proper evaluation whether benign or malignant by Trans-abdominal ultrasonography before treatment planning and further management. Results: In this study, mean age was 65. 8 years with standard deviation of mean ± 9. 7 years and the age ranged from 50 to 89 years. The most common symptoms associated with enlarged prostate were incomplete emptying 90%, frequency 84%, intermittency 80% urgency, 76%, weak stream, 70% straining 66%, nocturia 60%. Out of 50 patients, histopathological diagnosis of 44 (88%) was nodular hyperplasia, 2 (4%) was nodular hyperplasia with chronic prostatitis and rest of 4(8%) was adenocarcinoma of prostate. Conclusion: Ultrasonography is a non-invasive, available, radiation free procedure, which is used as a first line preliminary diagnostic procedure.

Nutritional Study of Picky Eaters: A Case Control Study

Background: Picky eating is a relatively common problem during childhood. Picky eating may cause parents considerable concern leading to physician visits and may cause conflict between parents regarding handling of their child’s eating behavior.
 Objectives: The present study was conducted to compare the nutritional status and daily calorie consumption among children with and without picky-eating-behavior.
 Methods: The present study was conducted out in the Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka and private chambers of paediatrician, general physician from July 2013 to December 2013. The case was defined as a child who had anorexia or took one or two favorite foods as explained by the parents in an otherwise healthy child with picky eating disorder, while a control was defined as a child without having picky eating disorder.
 Results: Thirty percent of the parents of cases complained that their children were not growing well as opposed to only 4% of the control group (p<0.05). Complaint of abdominal pain was considerably higher in the former group than that in the latter group (p<0.05). The history of forceful feeding was present in 20% of the cases compared to none in the control (p>0.05). The mean 24 hours intake of calorie was lower in the cases than that in the control, but the difference did not reach the level of significance (p>0.05). In terms of nutritional status very few children (8%) with picky eating behavior were wasted (low weight-for-height) (p>0.05). However, 26% of the picky-eaters were underweight in terms of BMI compared to 7% of the controls, but the difference was not statistically significant (p>0.05).
 Conclusion: The study concluded that the children with picky-eating-behavior are almost similar to their control counterparts in terms of nutritional status (wasting, stunting and BMI) and calorie consumption.
 DS (Child) H J 2021; 37(1): 59-63

Efficacy of Escitalopram (SSRI) for Better Glycemic Control in the Diabetic Depressive Patients

Background: Diabetes Mellitus is one of the most common disease in the world. Depression is most common among Diabetic patients, that causes morbidity and mortality. For prevention, we need to anti depressive agents with continued treatment for better compliance. So, it is important evaluate the efficacy of Escitalopram (SSRI) for better glycemic control in Diabetic Depressive patients.
 Objective: To assess the effect of Escitalopram (SSRI) on glycemic control in Type-2 Diabetic Depressive patients.
 Methods and Materials: A prospective observational study was done in Sir Salimullah Medical College and Mitford Hospital and BIRDEM General Hospital from January 2018 to December 2018.A total number of 35 diabetic and newly diagnosed depressive patients were taken and given tab. Escitalopram with continued diabetic treatment. Here, pre and post baseline investigations (FBG, Post prandial blood glucose and HbA1c levels) measured on day 1 , follow up at 6 weeks,12 weeks and then compared.
 Results: Patients treated with Escitalopram, pretreatment shows mean base line FBG 10.41 ±1.84mmol/L which was reduced to 8.56±1.55 mmol/L at 6 weeks and 7.51±1.26mmol/ L on 12 weeks. Similarly baseline mean 2HABF (post prandial) blood glucose 14.16±2.48mmol/L which was reduced to 12.41.01±2.34 mmol/L on 6 weeks and 10.96±1.75 mmol/L in 12 weeks .Mean baseline HbA1c 8.88±0.67% after in 12 weeks it was reduced to 7.82±0.98% . Here significant changed in blood glucose and HbA1c levels compared to pretreatment with Escitalopram (Treatment glucose and HbA1c levels compared to pretreatment with Escitalopram & only anti diabetic drugs.
 Conclusion: Escitalopram has better efficacy on glycemic control in Diabetic Depressive patients than patients treated with antidiabetic alone.
 Sir Salimullah Med Coll J 2021; 29(2): 100-104

Solid Tumor in Children: A Single Centre Experience

Introduction: Now a days, number of childhood tumors are gradually increasing throughout the world. But in Bangladesh we have no actual tumor register. In this study we just try to find out the demographic presentation of solid tumor in a tertiary care center of Dhaka city.
 Methods and materials: it is a retrospective descriptive type of observational study. Study was held in department of pediatric surgery, Sir Salimullah medical college Mitford hospital Dhaka from January 2016 to December 2020.
 Results: total number of the patients were 37. Male 15 and female 22. Male female ratio is 1:1.7. Age range of the patients from 9 days to 13 years. Mean age 135.83 days. Among 37 patients, 29 had malignant tumors and rest of 8 patients had benign tumor. Ovarian tumors were highest, 10. Then nephroblastoma 9, neuroblastoma 7, non Hodgkin lymphoma 3, sacrococcygeal teratoma 3, adrenal benign tumor 1, soft tissue sarcoma in pelvis 1, rhabdomyosarcoma of urinary bladder1, rectal carcinoma 1 and rhabdomyosarcoma of lower limb 1 accordingly. Most of the patients were went through surgery first then sent for chemotherapy according to histology.
 Conclusion: In spite of a tertiary medical care center in Dhaka city, our number of patient is not satisfactory. Lack of proper awareness in public, lots of patient did not reach to proper center, those who attained hospital, may lost. And our poor record keeping system is also responsible for adequate informations.
 Sir Salimullah Med Coll J 2021; 29(2): 117-120

Male Breast Cancer - A Case Report

Male breast cancer is a rare cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a disease that affects women, it does occurs in men. Male breast cancer is most common in older men, in between ages 60 and 70, though it can rarely occur under age 35. Common predisposing causes that raise odds for male breast cancer includes-breast cancer in a first degree relatives, history of radiation exposure to chest, enlarged breast (gynaecomastia) because of excess endogenous or exogenous estrogens, obesity, mutation of BRCA2 gene (common), cirrhosis of liver, history of some drugs intake, alcoholism, klinefelter’s syndrome, diseases of the testicles such as mumps orchitis or orchidectomy, prostate cancer or may be idiopathic. Here we present a case of older aged man who reported with a lump and itching of the left breast for one year in OPD of a general clinic in Munshigonj. The patient was referred to the unit-1, department of surgery, Sir Salimullah Medical College Mitford Hospital where clinical diagnosis was carcinoma of left breast.
 Sir Salimullah Med Coll J 2021; 29(2): 166-168

Comparative Evaluation of Quantitative Protein Measurement of 12-Hour and 24-hour Urine Sample for the Diagnosis of Nephrotic Syndrome and their Correlation with Spot Urinary Protein Creatinine Ratio

Background: The amount of protein excretion is a reflection of disease activity in Nephrotic Syndrome. 24-hour urine collection has remained as the method of choice to quantify proteinuria. An alternative method for quantitative evaluation of proteinuria is measuring the ratio of protein or albumin to creatinine in an untimed ‘‘spot’’ urine specimen.
 Objective: To compare 12-hour versus 24-hour proteinuria in nephrotic syndrome and its correlation to spot urinary protein creatinine ratio.
 Materials & Methods: A comparative cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College Mitford Hospital (SSMC & MH), Dhaka over a period from September 2016 to June 2017. All the babies developing 1st attack of Nephrotic Syndrome and meeting the clinical criteria were included in the study. Complete history was taken from accompanying attendants. Thorough clinical examinations and relevant laboratory investigations (12- hour day urinary protein, 12-hour night urinary protein, 24-hour urinary total protein, S. Albumin, S. Cholesterol, Urinary spot Protein Creatinine ratio) were done. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded and entered into computer for statistical analyses.
 Results: Out of 50 cases, the mean age was found 58.3±29.0 months. 12-hour day urinary protein was found 2.02±0.167 gm/m2/12 hours, mean; 12-hour night urinary protein was found 2.12±2.18 gm/m2/12 hours, mean; 24-hour urinary total protein was found 4.10±3.32 gm/m2/24 hours. The mean spot urinary protein creatinine ratio was found 12.58±7.21 with range from 2.02 to 29.85. There was no statistically significant difference between 12- hour day sample and 12-hour night sample. There was also no significant difference between 12-hour day & night sample with 24-hour sample. Results of all 03 samples were comparable to urinary protein creatinine ratio.
 Conclusion: This study reveals no statistically significant difference in quantitative estimation of 12-hour day and night protein with 24-hour urinary total protein. The 12- hour day and night protein and urinary total protein were comparable with each other and also with urinary spot protein creatinine ratio.So 12-hour day or night urinary total protein may be a diagnostic tool for nephrotic syndrome.
 Sir Salimullah Med Coll J 2021; 29(2): 105-111

Colonoscopy Screening Recommended as Earlier or Better an Investigation of Choice for Colorectal Symptoms

Background: Colonoscopic techniques have expanded the role of colonoscopy beyond conventional screening, surveillance, and diagnosis to various complex therapeutic and interventional utilities in colorectal diseases.
 Objective : (i) To determine the incidence of colorectal cancer in early and late onset. (ii) To determine the incidence in age cohort (iii) To compare clinico-epidemiological features in early and late onset (iv) To bring forth any discrepancies.
 Methods: It was prospective study conducted in Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Sir Salimullah Medical College Mitford Hospital, Dhaka total 200 cases were included in this study during the period January 2017 to June 2019.
 Results : Study shows out of 200 respondent 0.5% were under 31-40 years age, 4.5% were between 41-50, and 5.5% were above 50 years. Out of 200 respondent 8% were male in malignancy and 17.5% are benign and 3% were female in malignancy and 14% are benign. Male female ratio was 1.7:1 in malignancy. The most common clinical presentation were per-rectal bleeding (64%), then anaemia/weakness (46%), alteration of bowel habit (36%), pain (10.5%) and obstruction (3.5%).
 Conclusion: It concluded that proper equipment (colonoscope) and educated personnel, we can introduce colonoscopy as the mandatory screening method of examination, particularly for vulnerable groups.
 Sir Salimullah Med Coll J 2021; 29(2): 132-135

Diagnosis of Anorectal Tuberculosis by Polymerase Chain Reaction, GeneXpert And Histopathogenesis in Anal Fistula Patients

Background: Association of tuberculosis (TB) with anal fistulas can make its treatment quite difficult. The main challenge is timely detection of TB in anal fistulas and its proper management. There is little data available on diagnosis and management of TB in anal fistulas.
 Objective: To detect TB in fistula-in-ano patients were analyzed in different methods utilized. Methods: It was a prospective study conducted in Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University and Department of Surgery & Pathology, Sir Salimullah Medical College Mitford Hospital, Dhaka. Total 258 cases were included in this study during the period January 2018 to December 2020.The sampling was done for tissue (fistula tract lining) and pus (when available). The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were studied.
 Results: This study shows 84.1% were non TB fistula and 15.9% were TB fistula. Majority were male between non TB fistula and TB fistula which was 87.1% and 85.4% respectively. TB fistulas were more complex than non-tuberculous fistulas (68.3% vs 44.2%) respectively. TB was detected in (7.4%) samples tested by PCR-tissue, 23.6% samples tested by PCR-pus, (1.6%) samples tested with HPE-tissue and 0.8% samples tested by GeneXpert.
 Conclusion: This study shows the detection of TB by polymerase chain-reaction was higher than by histopathology and GeneXpert. Amongst polymerase chain-reaction, pus had a higher detection rate than tissue. TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups.
 Sir Salimullah Med Coll J 2021; 29(2): 121-123

Bacteriological Profile and Antibiotic Resistance Pattern in Children with Urinary Tract Infection in a Tertiary Care Hospital

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. The knowledge of bacterial causes of UTIs and their antimicrobial resistance patterns may help clinicians in choosing the appropriate antimicrobials.
 Objectives: The present study was designed to find out the bacteriological profile of urinary tract infection and their antibiotic resistance pattern in children.
 Methodology: A cross sectional study was done in the department of Microbiology, Sir Salimullah Medical College from January to December 2019. Midstream urine samples were collected from clinically suspected cases of UTI in the age group of 0 to 18 years from various indoor and outdoor patients of Mitford hospital for this study.
 Results: Out of 2763 cases, 363 were culture positives, where females were 202(55.65%) with highest number of cases within the age group of 0 to 4 years (63.36%). Most common isolate identified was Escherisia coli, followed by Pseudomonas, Proteus, Morganella and only Gram positive bacteria was S. aureus. Organisms show highest resistance to Amoxiclav, Cefixime, Cotrimoxazole, Ciprofloxacin and highest sensitivity to Amikacin.
 Conclusion: This study revealed that UTI was more common in female & under five children. Escherichia coli were the commonest isolated organism and all isolates show high resistance to common antimicrobial agents.
 Sir Salimullah Med Coll J 2021; 29(2): 112-116

In-hospital Outcome of Acute Anterior Myocardial Infarction with Right Ventricular Dysfunction

Background: In anterior ST-segment elevation myocardial infarction (STEMI), attention paid mainly to the left ventricle. The predictive significance of right ventricular (RV) dysfunction in patients with anterior STEMI has been frequently neglected. In this study, we evaluated the prognostic effect of RV dysfunction on in-hospital outcomes in patients with first anterior STEMI. Methods: Present study is based on the analysis of 77 patients admitted to Coronary care unit of the Sir Salimullah Medical College & Mitford Hospital, Dhaka during April, 2019 to March, 2020, with acute anterior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with echocardiographic assessment of RV and LV function within index hospitalization, preferably within 24 hours of admission. Patients were divided into two groups depending on right ventricular function assessment. Group I included anterior MI with right ventricular dysfunction and group II included anterior MI without right ventricular dysfunction. In hospital outcomes were observed and compared between two groups. Results: Patients with RV dysfunction had statistically significant higher incidence of cardiogenic shock (22.2 % vs. 2.4%, p < 0.05), acute heart failure (69.4% vs. 24.4%, p < 0.05), arrhythmia (11.1% vs. 0.0%, p < 0.05), increase length of hospital stay in patients of RV dysfunction group. In-hospital mortality was non significantly higher in RV dysfunction group (8.3% vs. 2.4%, p > 0.305). Conclusion: In this study, we observed that in-hospital outcomes were worse in patients with anterior STEMI with RV dysfunction and demands more intense invasive management. Thus, special care should be given for the assessment function of right ventricle in anterior STEMI. Cardiovasc j 2022; 14(2): 128-134

Evaluation of Drug Prescribing Patterns in Dermatology Outpatient Department of Two Teaching Hospitals in Bangladesh

Background: Skin diseases are common and cause a huge burden globally. Bangladesh is known to have a high prevalence of skin diseases. Considering the economic burden of the skin diseases treatment and its high prevalence, it is important to study the drug prescribing patterns in skin diseases.
 Objective: To evaluate the prescribing pattern of drug according to World Health Organization (WHO) prescribing indicators among the patients attending Dermatology outpatient department in two teaching hospitals.
 Materials and method: A cross sectional descriptive study was conducted in outpatient department of Dermatology in Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) from July 2015 to June 2016. A total number of 600 prescriptions (300 from each hospital) were enrolled in the study. The general information and data were collected in the questionnaire and subjected to evaluation using WHO prescribing indicators.
 Results: The average number of drugs per prescription was 2.41 in DMCH and 2.38 in SSMC & MH. Only 23.72% drugs in DMCH and 27.79% drugs in SSMC & MH were prescribed by generic name. The percentage of prescriptions with antibiotics was 46% in DMCH and 45.66% in SSMC & MH. The percentage of prescriptions with an injection encountered was 0.67% and 0.33% in DMCH and SSMC & MH respectively. This study also revealed that, the percentage of drugs prescribed from the Essential Drug List (EDL) of Bangladesh was 56% in DMCH and 57.68% in SSMC & MH.
 Conclusion: There is need to emphasize to keep the average number of drugs as low as possible and encourage prescribing by generic name and from Essential Drug List (EDL).
 Delta Med Col J. Jul 2020 8(1): 9-14